Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 631 | LA |
N | 103T00000X | Psychologist | 631 | LA |
N | 103TC1900X | Counseling Psychologist | 631 | LA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 631 | LA |
N | 103TF0000X | Family Psychologist | 631 | LA |
Y | 103TP0016X | Prescribing (Medical) | 631MP | LA |
N | 103TP0016X | Prescribing (Medical) | MPAP.000013 | LA |
N | 103TS0200X | School Psychologist | 631 | LA |
NPI | 1043327968 |
---|---|
Provider Name | Dr. Bruce K Mccormick |
First Address | Shreveport, LA 71101-4608 |
Second Address | Shreveport, LA 71101-4608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 05/04/2021 |